1891153540 NPI number — MS. KRISTEN LYNN JINDRA MA, LPCC

Table of content: DR. SCOTT T ODOM D.D.S. (NPI 1932232493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891153540 NPI number — MS. KRISTEN LYNN JINDRA MA, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JINDRA
Provider First Name:
KRISTEN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERCHINSKE
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891153540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24600 DETROIT RD STE 240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44145-2542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-249-7990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20220 CENTER RIDGE RD STE 355
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY RIVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44116-3596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-249-7990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  E1800980 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)